Pathoma - 11 (Exocrine, Gallbladder, Liver)

welejofo's version from 2017-05-07 23:25

Section 1

Question Answer
What are 2 common causes of acute pancreatits?alcohol and gallstones
how does alcohol cause acute pancreatitis?alcohol causes contractions of sphincter of oddi --> blocks drainage
which is more specific for PANCREATIC damage: lipase or amylase?lipase!
elevated serum lipase indicates?pancreatic damage
what bacteria causes pancreatic abscesses?E. coli
whats the most common cause of chronic pancreatitis in CHILDREN?CF
pt with abd pain shows contrast study with "chain of lakes" pattern due to dilation of pancreatic ductschronic pancreatitis
what are the 2 most important risk factors of pancreatic carcinoma?SMOKING and chronic pancreatitis
CA 19-9pancreatic adenocarcinoma
thin elderly pt presents with diabetes and abd pain..think of?pancreatic adenocarcinoma
how come pts with Crohns disease develop gallstones?damage to terminal ilieum --> poor reabsorption of bile salts (which normally increase solubility)
chinese liver flukeclonochis
chinese liver fluke that causes biliary infection, cholangitis and cholangiocarcinomaclonorchis
name 2 worms taht infect the biliary tract, increasing risk for gallstones?ascarcis lumbricoides and clonorchis
pt presents with RUQ pain radiating to RIGHT SCAPULAacute cholecystitis
what characterizes chronic cholecytitis? (think of the mucosa)herniation of gallbladder mucosa into muscular wall = Rokitansky-Aschoff Sinus
Rokitansky-Aschoff sinussign of chronic cholecystitis
whats a late complication of chronic cholecystitis?porcelain gallbladder

Section 2

Question Answer
What is choledocholithiasisstones in biliary ducts
elderly woman presents with cholecystitis...diagnosis?gallbladder carcinoma
what molecule makes urine YELLOW?urobilogen (colorless) --> urobilin (YELLOW)
describe the metabolism of bilirubin1) RBCs are consumed by macrophages of the RES
2) RBCs are broken down to Hb --> heme and protoporphryin
3) protoporphyrin is convered to UCB and albumin carries UCB to liver
4) uridine glucuronyl transferase (UGT) conjugates bilirubin
5) CB is transferred to bile caniculi to form bile and stored in gallbaldder
6) bile is released into small bowel
7) intestinal flora converts CB to urobilinogen. Urobilinogen is partially reabsorbed into blood and filtered by kidney to make urine yellow
what causes dark urine in pts with extravascular hemolysis?due to increase in urine urobilinogen (NOT UCB since it is NOT water soluble and hence absent in urine)
whats the tx for physiologcal jaundice of newborn?phototherapy since it makes UCB water soluble
pt with low uridine gluconuryl transfersaseGilberts syndrome --> see increased UCB
what causes Crigler Najjar syndrome?absent uridine gluconuryl transferase --> increase UCB
what causes dubin-johnson syndrome?deficiency of bilirubin canalicular transport protein --> see increased CB
what is Rotor syndrome?deficiency of bilirubin canicular transport protein EXCEPT with NO BLACK LIVER
pt with jaundice presents with increase CB, decrease urine urobilinogen, and increased ALKPbiliary tract obstruction = obstructive jaundice
pt with jaundice shows both increase in UCB and CB...diagnosis?viral hepatitis

Section 3

Question Answer
how long does acute hepatitis last for? chronic hepatitis?acute hepatitis: < 6 months. chronic hepatitis: >6 months
why do you see both increased CB and UCB in viral hepatitis?CB: destruction of ductules that leak out CB. UCB: destruction of hepatocytes means less conjugating ability!
liver shows bands of fibrosis and regenerative nodules of hepatocytescirrhosis
what causes fibrosis in cirrhosis?fibrosis is mediated by TGF-beta from stellate cells which lie beneath the endothelial cells that line sinusoids
spider angiomata, palmar erythema, and gynecomastia are signs of?excess estrogen -- liver plays a role in removing estrogen from blood!
what mediates damage in alcoholic hepatitis?acetaldehyde
what are mallory bodies made of?damaged cytokeratin filaments
what are the 2 causes of hemochromatosis?defect in iron absorption (primary) or CHRONIC TRANSFUSIONS (secondary)
what mutation is seen in hemochromatosis?HFE mutation (cysteine --> tyrosine at 282)
what is lipofuscin?by-product of peroxidized lipids
mutation in ATP7B gene in ATP-mediated hepatocyte copper transportwilsons disease
mutation in ATP7B gene causes what change for copper?lack of copper transport into bile and lack of copper incorporation into ceruloplasmin --> copper builds up in hepatocytes and tissues
autoimmune granulomatous destruction of intrahepatic bile ductsprimary biliary cirrhosis
antimitochondiral antibodyprimary biliary cirrhosis
AMA+ primary biliary cirrhosis
inflammation and FIBROSIS of intrahepatic and extrahepatic bile ducts?primary sclerosing cholangitis
periductal fibrosis with "onion skin" appearanceprimary sclerosing cholangitis
primary sclerosing cholangitis is associated with which inflammatory bowel disease?ULCERATIVE COLITIS!
marker for primary sclerosing cholangitisp-ANCA

Section 4

Question Answer
what causes fulminant hepatitic damage in reyes syndrome?mitochondiral damage of hepatocytes
Benign tumor of hepatocyteshepatic adenoma
Whats a risk factor for hepatic adenomaOCP
hepatic tumor taht grows in response to estrogenhepatic adenoma
maligant tumor of hepatocyteshepatocellular carcinoma
doctor feels nodules on the free edge of liver during physical exam...nodular free edge indicates?metastasis to liver
what is budd chiari syndrome?liver infarction secondary to hepatic vein obstruction (portal vein--> liver --> hepatic vein)

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